Provider Demographics
NPI:1568763258
Name:SY, STEPHANIE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4255 CY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4247
Mailing Address - Country:US
Mailing Address - Phone:307-232-9605
Mailing Address - Fax:307-232-9607
Practice Address - Street 1:4255 CY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-4247
Practice Address - Country:US
Practice Address - Phone:307-232-9605
Practice Address - Fax:307-232-9607
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist